A bibliometric analysis of published literature on membrane photobioreactors for wastewater treatment from 2000 to 2022

With the focus on limiting greenhouse gas emissions, microalgae-based technology is a promising approach for wastewater treatment, combining cost-effective operation, nutrient recovery, and assimilation of CO2. In addition, membrane technology supports process intensification and wastewater reclamation. Based on a bibliometric analysis, this paper evaluated the literature on membrane photobioreactors to highlight promising areas for future research. Specifically, efforts should be made on advancing knowledge of interactions between algae and bacteria, analysing different strategies for membrane fouling control and determining the conditions for the most cost-effective operation. The Scopus® database was used to select documents from 2000 to 2022. A set of 126 documents were found. China is the country with the highest number of publications, whereas the most productive researchers belong to the Universitat Politècnica de València (Spain). The analysis of 50 selected articles provides a summary of the main parameters investigated, that focus in increasing the biomass productivity and nutrient removal. In addition, microalgal-bacterial membrane photobioreactor seems to have the greatest commercialisation potential. S-curve fitting confirms that this technology is still in its growth stage.

Evaluation of microsatellite loci from libraries derived from the wild diploid 'Calcutta 4' and 'Ouro' banana cultivars

Microsatellite markers have been widely used in the quantification of genetic variability and for genetic breeding in Musa spp. The objective of the present study was to evaluate the discriminatory power of microsatellite markers derived from 'Calcutta 4' and 'Ouro' genomic libraries, and to analyze the genetic variability among 30 banana accessions. Thirty-eight markers were used: 15 from the 'Ouro' library and 23 from the 'Calcutta 4' library. Genetic diversity was evaluated by considering SSR markers as both dominant markers because of the presence of triploid accessions, and co-dominant markers. For the dominant analysis, polymorphism information content (PIC) values for 44 polymorphic markers ranged from 0.063 to 0.533, with a mean value of 0.24. A dendrogram analysis separated the BGB-Banana accessions into 4 groups: the 'Ouro' and 'Muísa Tia' accessions were the most dissimilar (93% dissimilarity), while the most similar accessions were 'Pacovan' and 'Walha'. The mean genetic distance between samples was 0.74. For the analysis considering SSR markers as co-dominants, using only diploid accessions, two groups were separated based on their genome contents (A and B). The PIC values for the markers from the 'Calcutta 4' library varied from 0.4836 to 0.7886, whereas those from the 'Ouro' library ranged from 0.3800 to 0.7521. Given the high PIC values, the markers from both the libraries showed high discriminatory power, and can therefore be widely applied for analysis of genetic diversity, population structures, and linkage mapping in Musa spp.

Genetic diversity among Puccinia melanocephala isolates from Brazil assessed using simple sequence repeat markers

Brown rust (causal agent Puccinia melanocephala) is an important sugarcane disease that is responsible for large losses in yield worldwide. Despite its importance, little is known regarding the genetic diversity of this pathogen in the main Brazilian sugarcane cultivation areas. In this study, we characterized the genetic diversity of 34 P. melanocephala isolates from 4 Brazilian states using loci identified from an enriched simple sequence repeat (SSR) library. The aggressiveness of 3 isolates from major sugarcane cultivation areas was evaluated by inoculating an intermediately resistant and a susceptible cultivar. From the enriched library, 16 SSR-specific primers were developed, which produced scorable alleles. Of these, 4 loci were polymorphic and 12 were monomorphic for all isolates evaluated. The molecular characterization of the 34 isolates of P. melanocephala conducted using 16 SSR loci revealed the existence of low genetic variability among the isolates. The average estimated genetic distance was 0.12. Phenetic analysis based on Nei's genetic distance clustered the isolates into 2 major groups. Groups I and II included 18 and 14 isolates, respectively, and both groups contained isolates from all 4 geographic regions studied. Two isolates did not cluster with these groups. It was not possible to obtain clusters according to location or state of origin. Analysis of disease severity data revealed that the isolates did not show significant differences in aggressiveness between regions.

Search for methylation-sensitive amplification polymorphisms in mutant figs

Fig (Ficus carica) breeding programs that use conventional approaches to develop new cultivars are rare, owing to limited genetic variability and the difficulty in obtaining plants via gamete fusion. Cytosine methylation in plants leads to gene repression, thereby affecting transcription without changing the DNA sequence. Previous studies using random amplification of polymorphic DNA and amplified fragment length polymorphism markers revealed no polymorphisms among select fig mutants that originated from gamma-irradiated buds. Therefore, we conducted methylation-sensitive amplified polymorphism analysis to verify the existence of variability due to epigenetic DNA methylation among these mutant selections compared to the main cultivar 'Roxo-de-Valinhos'. Samples of genomic DNA were double-digested with either HpaII (methylation sensitive) or MspI (methylation insensitive) and with EcoRI. Fourteen primer combinations were tested, and on an average, non-methylated CCGG, symmetrically methylated CmCGG, and hemimethylated hmCCGG sites accounted for 87.9, 10.1, and 2.0%, respectively. MSAP analysis was effective in detecting differentially methylated sites in the genomic DNA of fig mutants, and methylation may be responsible for the phenotypic variation between treatments. Further analyses such as polymorphic DNA sequencing are necessary to validate these differences, standardize the regions of methylation, and analyze reads using bioinformatic tools.

Establishing references for gene expression analyses by RT-qPCR in Theobroma cacao tissues

Lack of continuous progress in Theobroma cacao (Malvaceae) breeding, especially associated with seed quality traits, requires more efficient selection methods based on genomic information. Reverse transcript quantitative PCR (RT-qPCR) has become the method of choice for gene expression analysis, but relative expression analysis requires various reference genes, which must be stable across various biological conditions. We sought suitable reference genes for various tissues of cacao, especially developing seeds. Ten potential reference genes were analyzed for stability at various stages of embryo development, leaves, stems, roots, flowers, and pod epicarp; seven of them were also evaluated in shoot tips treated either with hormones (salicylate; ethefon; methyl-jasmonate) or after inoculation with the fungus Moniliophthora perniciosa (Marasmiaceae sensu lato). For developing embryos, the three most stable genes were actin (ACT), polyubiquitin (PUB), and ribosomal protein L35 (Rpl35). In the analyses of various tissues, the most stable genes were malate dehydrogenase (MDH), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), and acyl-carrier protein B (ACP B). GAPDH, MDH and tubulin (TUB) were the most appropriate for normalization when shoot apexes were treated with hormones, while ACT, TUB and Rpl35 were the most appropriate after inoculation with M. perniciosa. We conclude that for each plant system and biological or ontogenetical condition, there is a need to define suitable reference genes. This is the first report to define reference genes for expression studies in cacao.

Development of an integrated genetic map of a sugarcane (Saccharum spp.) commercial cross, based on a maximum-likelihood approach for estimation of linkage and linkage phases

Sugarcane (Saccharum spp.) is a clonally propagated outcrossing polyploid crop of great importance in tropical agriculture. Up to now, all sugarcane genetic maps had been developed using either full-sib progenies derived from interspecific crosses or from selfing, both approaches not directly adopted in conventional breeding. We have developed a single integrated genetic map using a population derived from a cross between two pre-commercial cultivars ('SP80-180' x 'SP80-4966') using a novel approach based on the simultaneous maximum-likelihood estimation of linkage and linkage phases method specially designed for outcrossing species. From a total of 1,118 single-dose markers (RFLP, SSR and AFLP) identified, 39% derived from a testcross configuration between the parents segregating in a 1:1 fashion, while 61% segregated 3:1, representing heterozygous markers in both parents with the same genotypes. The markers segregating 3:1 were used to establish linkage between the testcross markers. The final map comprised of 357 linked markers, including 57 RFLPs, 64 SSRs and 236 AFLPs that were assigned to 131 co-segregation groups, considering a LOD score of 5, and a recombination fraction of 37.5 cM with map distances estimated by Kosambi function. The co-segregation groups represented a total map length of 2,602.4 cM, with a marker density of 7.3 cM. When the same data were analyzed using JoinMap software, only 217 linked markers were assigned to 98 co-segregation groups, spanning 1,340 cM, with a marker density of 6.2 cM. The maximum-likelihood approach reduced the number of unlinked markers to 761 (68.0%), compared to 901 (80.5%) using JoinMap. All the co-segregation groups obtained using JoinMap were present in the map constructed based on the maximum-likelihood method. Differences on the marker order within the co-segregation groups were observed between the two maps. Based on RFLP and SSR markers, 42 of the 131 co-segregation groups were assembled into 12 putative homology groups. Overall, the simultaneous maximum-likelihood estimation of linkage and linkage phases was more efficient than the method used by JoinMap to generate an integrated genetic map of sugarcane.

Influence of the interval between the administration of doxorubicin and paclitaxel on the pharmacokinetics of these drugs in patients with locally advanced breast cancer

PURPOSE

The combination of bolus doxorubicin followed by a 3-h infusion of paclitaxel has high antitumor activity in patients with metastatic breast cancer, but is limited by unexpected cardiac toxicity. In contrast, the administration of the two drugs 16 h apart has similar antitumor activity but less cardiac toxicity. The purpose of this study was to compare the pharmacokinetics of these drugs when doxorubicin administration preceded paclitaxel by 30 min or by 24 h.

PATIENTS AND METHODS

Women with locally advanced breast cancer were treated with doxorubicin (60 mg/m2 i.v. bolus) followed 24 h later by paclitaxel (200 mg/m2 i.v. over 3 h) for six cycles (four before and two after surgery). In one of the first two cycles doxorubicin preceded paclitaxel by 30 min instead of 24 h, with plasma sampling for pharmacokinetic analysis up to 48 h. Determination of drug levels in plasma was done by HPLC.

RESULTS

A total of 28 patients were included. No clinical cardiac toxicity was observed but five patients discontinued doxorubicin-paclitaxel treatment after four cycles because of a decrease in LVEF of at least 15% from baseline or to less than 50%. While paclitaxel pharmacokinetics were not changed, there was a 30% and an 80% increase in the AUC0, 24h for doxorubicin and doxorubicinol, respectively, when the drugs were administered 30 min instead of 24 h apart. Even when paclitaxel was given 24 h after doxorubicin, there was a rebound 240% increase in the plasma concentration of doxorubicinol.

CONCLUSIONS

Paclitaxel interferes with the pharmacokinetics of doxorubicin leading to higher systemic exposure to both doxorubicin and doxorubicinol, which is more evident when the plasma concentration of the anthracyclines is higher. This interference may explain the higher incidence of cardiac toxicity observed when the two drugs are administered within a short interval.

[Impact of Spanish publications on foreign anesthesiology journals]

OBJECTIVE

To analyze the number of articles by Spanish authors in three international anesthesiology journals and assess the impact of Spanish anesthesiology literature during the same period by way of citations.

MATERIAL AND METHODS

Articles published in Anesthesiology, British Journal of Anesthesiology (BJA) and Anesthesia & Analgesia (Anesth Analg) during 1997 were reviewed. We collected the following data: type of document, country of origin of the authors, total number of references, number of citations of Spanish articles and the journals from which they were cited. Later, the Spanish contribution was compared to that of other countries of the European Union, with data considered in function of Gross National Product per capita (GNPpc) of each country.

RESULTS

The incidence of Spanish articles published in Anesthesiology, BJA and Anesth Analg was 0.37%, 0.71% and 0.9%, respectively. The production of Spanish documents in function of GNPpc ranked Spain in the tenth position in Anesthesiology, eleventh in BJA and sixth in Anesth Analg. Of the total number of citations, 143 (0.4%) were of Spanish publications. In Spanish articles in Anesthesiology the percentage of Spanish citations was 11%, in BJA the figure was 44% and in Anesth Analg it was 13%. Finally, over 90% of the Spanish articles cited in Anesthesiology and in Anesth Analg were published in English in foreign journals.

CONCLUSIONS

The number of Spanish articles published in Anesthesiology, BJA, and Anesth Analg is low, although the comparison of our productivity with that of other EU countries in function of GNPpc places us in an intermediate position. The impact of Spanish literature on international studies is low, particularly research published in Spanish national journals, a circumstance that is reflected even in articles published by Spanish authors.

[Preloading with 500 ml of Hartmann's solution lessens the incidence and severity of hypotension and reduces the need for ephedrine after epidural anesthesia in ambulatory patients]

INTRODUCTION

Fluid preloading to prevent hypotension after epidural anesthesia has been widely questioned, although few studies have been performed in outpatients.

OBJECTIVE

To evaluate the incidence and severity of hypotension, and the need for vasoactive agents after epidural anesthesia in outpatients who did or did not receive fluid preloading.

PATIENTS AND METHODS

Forty patients under 55 years of age (ASA I and II) undergoing general surgery on an outpatient basis were assigned randomly to two groups of 20 according to whether they were to receive loading with Hartmann's solution or not before epidural anesthesia. All received a similar epidural dose of 2% mepivacaine. Hypotension was defined as a decrease of 20% in systolic or mean blood pressure in comparison with baseline, or absolute pressures of < 90 and 60 mmHg, respectively. Hypotension was treated with 5 mg boluses of ephedrine.

RESULTS

Fourteen patients in the non-preloading group and 5 in the preloading group developed hypotension (p < 0.05). Hypotensive episodes were fewer in patients receiving preloading fluids (0.5 +/- 1.2 versus 2.0 +/- 2.4; p < 0.05). The ephedrine dose required was higher in non-preloaded patients than in preloaded ones (10.0 +/- 12.2 versus 2.6 +/- 6.3 mg; p < 0.05). Time until presentation of hypotension was longer for non-preloaded patients.

CONCLUSIONS

For patients undergoing outpatient surgery, fluid preloading with 500 ml of Hartman's solution decreases both the incidence and severity of hypotension, as well as the need for vasoactive drugs after epidural anesthesia.

[Upper gastrointestinal hemorrhage caused by a fistula from a right anomalous subclavian artery to the esophagus]

Bleeding from an arterio-esophageal fistula is a rare and nearly lethal condition and surgical treatment is the only curative option. We report a case of bleeding from a fistula from an aberrant right subclavian artery to the esophagus. Diagnosis was made only at necropsy, despite of three previous laparotomies. This anatomical variation is found in 0.5% of the general population. Development of a communication between this artery and the esophagus, secondary to aneurysmatic dilatation or to prolonged nasogastric intubation, as probably occurred with this patient, is a extremely rare condition. Surgical treatment depends on the early recognition of clinical signs of the arterio-esophageal communication, before the onset of systemic complications of hypovolemic shock.

[Fuzzy logic and postoperative pain]

OBJECTIVE

To apply a fuzzy logic expert control system for the treatment of postoperative pain in a clinical setting.

MATERIAL AND METHODS

A system was designed consisting of a perfusion pump guided by a fuzzy logic computer interface to regulate the perfusion of alfentanil in accordance with the patient's pain response. The system was also equipped with a safety device that halted perfusion in case of desaturation, bradypnea or heart rate or blood pressure variations greater than 25%. The system was used in the first 90 minutes after surgery in a patient who underwent bilateral saphenectomy.

RESULTS

All system functions worked properly, maintaining the target analgesic values (visual analog scale < or = 2) 77% of the time.

CONCLUSION

It is possible to use fuzzy logic to obtain adequate treatment of postoperative pain.

[Postoperative complications and mortality in abdominal aortic aneurysm surgery]

OBJECTIVE

To analyze morbidity and mortality in patients undergoing surgery for aneurysm of the abdominal aorta, in order to identify risk factors.

PATIENTS AND METHODS

We conducted a retrospective study of 143 patients with aortic aneurysm undergoing surgery between January 1986 and April 1993. One hundred twenty-seven aneurysms were infrarenal and 16 were adjacent to the kidney.

RESULTS

Surgery was scheduled in 67.1% of the cases, emergency in 27.2% and deferred in 5.59%. The mortality for each of these groups was 8.3%, 33.3% and 62.5%, respectively. Exitus took place within the first 24 hours after admission. Secondary diseases, usually ischemic cardiopathy, were present in 68.5%. The most frequently observed postoperative complications were cardiovascular, followed by renal, respiratory and digestive problems. The most frequent cause of death was acute myocardial infarction, followed by hypovolemic shock in emergency patients. Factors representing significant risk of mortality were age over 80 years (p < 0.001), aneurysmatic rupture (p < 0.001) and blood loss requiring transfusion of more than 4 units of packed red cells during surgery (p < 0.001).

CONCLUSIONS

The increase in the number of elective procedures (including scheduled resection of small aneurysms), early diagnosis and treatment of ruptures and aggressive hemodynamic management in the perioperative period--with special attention to cardiovascular status in the first 24 hours after surgery--are all factors that can contribute to better outcome.

[Comparative study of clonidine and lidocaine on the attenuation of the intraocular pressure increase associated with laryngoscopy and endotracheal intubation]

OBJECTIVE

To verify and compare the efficacy of clonidine and lidocaine for attenuating the ocular hypertensive response generated by manipulation of the laryngoscope and endotracheal intubation (EIT).

PATIENTS AND METHODS

In this prospective double blind study 45 patients undergoing non-ocular surgery were divided into 3 groups according to pretreatment protocol: A, approximately 3 micrograms/kg clonidine orally 90-120 min before surgery; B, 1.5 mg/kg intravenous lidocaine 1 min before EIT and C, control group. On all patients we recorded intraocular pressure (IOP), mean arterial pressure and heart rate at the following times: basal, just before EIT, immediately after EIT, 5 minutes later and 10 minutes later.

RESULTS

The patients pretreated with clonidine had significantly lower IOP levels than did the control group at all measurements times; patients pretreated with lidocaine had lower IOP after induction and after intubation. IOP was significantly lower in patients who received lidocaine than in control group patients after EIT, although IOP levels with lidocaine were higher than with clonidine.

CONCLUSIONS

Pretreatment with oral clonidine is an effective method for preventing increases in IOP after EIT, is more effective than pretreatment with lidocaine, and should therefore be used for that end. Intravenous lidocaine represents a valid alternative in emergency cases when the approximate wait time of 2 hours is contraindicated.

[Transduodenal endoscopic drainage of pancreatic pseudocysts and peripancreatic collection]

Until recently, the treatment of pancreatic pseudocysts was mainly surgical. However, two non-surgical invasive approaches are now possible: percutaneous aspiration under ultrasonic or CT monitoring and endoscopic drainage. PURPOSE--To report the result obtained using endoscopic drainage of pancreatic pseudocysts. METHODS--11 consecutive patients admitted with pancreatic pseudocyst had chronic pancreatitis and 1 patient had a well defined paraduodenal collection originated from acute necrotising pancreatitis. Endoscopic cystoduodenostomy was performed in the area of close contact with the digestive wall. A standard Olympus duodenoscope was used to reach the bulging wall and to allow the diatermic fistula. RESULTS--The success rate was 91.7%. Hemorrhage occurred in 1 patient (8.3%) controlled without blood transfusion. Endoscopic cystoduodenostomy was the definitive treatment in 10 patients 36 months after the procedure. One patient underwent gastrojejunostomy after 14 months for duodenal obstruction following relapsing pancreatitis. There was no relapsing cyst. There was no death following the endoscopic procedure. CONCLUSION--the endoscopic cystoduodenostomy constitutes an alternative procedure for the drainage of paraduodenal pseudocysts whenever restricted to the precise morphological indication of paraintestinal pseudocyst bulging into the duodenal lumen.

[Obstetric and gynecologic anesthesia reported in the "Revista Española de Obstetricia y Ginecología" (1916-1936)]

This study follows the evolution of anesthesia in gynecology and obstetrics in Spain between 1916 and 1936. Research included revising all articles and references concerning anesthesiology appearing in the Revista Española de Obstetricia y Ginecologia over the 20 years during which that journal was published. Eighty-three articles were found: 18 (21.6%) original research reports, 37 (44.6%) reviews of the Spanish professional literature and 28 (33.7%) summaries and descriptions of meetings of scientific organizations. Spanish references constituted 39.8% with the remaining 60.2% coming from European and Hispano-American sources. Twenty-four (34.9%) were related to spinal anesthesia, 15 (18%) covered various methods for analgesia during childbirth and 14 (16.8%) were on barbiturates. The remaining articles referred to rectally administered anesthesia, local anesthesia, inhalatory anesthesia and pain in gynecology. In conclusion, our review reveals the strong international contacts in Spanish gynecology during this period, as well as the interest of gynecologists and obstetricians in various anesthetic techniques and the rapid incorporation of new methods into their therapeutic arsenal.

[Endoscopic sclerotherapy of bleeding esophagogastric varices and functional liver status]

Endoscopic sclerotherapy of bleeding gastroesophageal varices was carried out in 52 patients within a sclerosis program for acute hemorrhage. According to Child's classification, 18 (34.6%) were A, 12 (23.1%) B and 22 (42.3%) C. The hemorrhagic focus was endoscopically proven in oesophageal varices in 45 (86.5%) and in 7 (13.5%) in gastric varices. The sclerotherapy was performed by both intra and extravascular injections of 3% ethanolamine according to treatment for emergency bleeding. The procedure was repeated on the 7th day or when necessary for recurrent hemorrhage. Hemostasis was achieved in 94.4% Child's class A, 75.0% Child's class B and 54.5% Child's class C, all of them with bleeding oesophageal varices. All patients with severe gastric hemorrhage (2 Child's class A, 2 Child's class B and 3 Child's class C) needed surgical treatment for uncontrolled bleeding. Liver failure and bleeding were the leading causes of death in 15 (68.1%) Child's class C and 2 (16.6%) Child's class B. There was no death in Child's class A. The conclusion was drawn that the results of endoscopic sclerotherapy of bleeding oesophageal varices was effective and clearly related to liver function. The endoscopic sclerotherapy, however, was not able to control severe hemorrhage from gastric varices and this was not related to liver function.

[Presentation of 2 cases of neuromuscular excitation associated with propofol]

The cases of two patients who received peridural and intradural anesthesia and propofol as sedation are presented. In one case generalized tonic and clonic convulsions, and in the other, opisthotonos appeared. Neither patient had previous neurologic disease nor, in the context of complications, did other causes to explain the same appear except for the possible association with propofol to which similar secondary effects have been described.

Ocular changes in familial amyloidotic polyneuropathy with dense vitreous opacities

Familial amyloid polyneuropathy (FAP) is a hereditary disease which eventually causes serious ocular problems. Seven eyes from patients with FAP 1 were vitrectomised, and the insoluble proteins from the vitreous were purified, the amyloid protein isolated, and the prealbumin characterised with a monoclonal antibody against amyloid fibril protein. Before surgery, visual acuity was very poor, due to abundant deposits in the vitreous, frequently attached to the posterior lens capsule. The pupil had peculiar indentations and the pupillary reflexes were abnormal. Intraocular pressure (IOP) was at the upper limit of normal. In the ocular fundus an intraretinal perifoveal gray ring was sometimes seen. Vitrectomy improved visual acuity, but the reappearance of vitreous deposits reduced it to 8.8/10 after 33.4 months, when treatment was needed for most of the eyes to control IOP. Amyloid and the mutant form of prealbumin characteristic of FAP 1, TTR Met 30, were shown to be present in the vitreous.

Cardiac amyloidosis: report of a patient heterozygous for the transthyretin isoleucine 122 variant

Amyloid fibril material was extracted from autopsy material of a patient who died from progressive cardiac failure at age 64. He had enlarged heart on routine X-ray at age 47 and the first symptoms of cardiac failure at age 62. Fractionation of the fibril material resolved peptide fragments immunoreactive with anti-human transthyretin (TTR). One of the peptides was further purified by high-performance liquid chromatography (HPLC) and subjected to tryptic peptide mapping along with TTR isolated from the patient's serum. In both instances, sequencing procedures revealed, in addition to the normal peptide 12 (residues 105-126), an abnormal peptide with an isoleucine for valine substitution at position 122. This substitution has been described previously in a patient with systemic senile amyloidosis (SSA) homozygous for this variant. The results question whether SSA is a clinical entity related to TTR Ile 122 with phenotypic expression in the homozygous condition.

[Immediate and late results of surgical alternatives in the treatment of non-resectable duodenal ulcers (author's transl)]

The authors present 69 patients with duodenal ulcer considered as non-resectable ("difficult duodenum"). Troncular vagotomy associated with gastrojejunostomy (VTGE) were performed in 26 cases. This surgical approach was chosen for patients with advanced age, poor general condition and, obesity. When local conditions such as deformity, post-bulbar ulcer and penetrating ulcers were present, troncular vagotomy with antrectomy and Finsterer exclusion (VTAF) was the procedure of choice (43 cases). The incidence of duodenal fistula during the hospital stay was high (6,9%) in the VTAF group but the mortality rate was low, as oposed to the high mortality rate after VTGE. This is in agreement with other authors. Regarding the late results (follow-up for over 1 year in 58.3% of the VTGE group and, 70.5% of the VTAF group) a recurrence rate of 16.6% was observed in the VTGE group and, none in the CTAF group. The authors conclude that in the non-resectable duodenum, the procedure of choice is troncular vagotomy with antrectomy and Finsterer exclusion. Troncular vagotomy and jejunostomy should be considered as an alternative and, performed only in obese patients, over the age of 65 and in poor general condition.